The Washington Postreports that the U.S. Attorney's office for Eastern Virginia has settled federal allegations for poor care with owners of seven Virginia nursing homes and two management companies. U.S. Attorney Paul McNulty of the this office calls these settlement agreements innovative. Instead of fining the nursing homes and companies, they require that the owners re-invest the money in nursing home improvements, i.e., hiring more employees and a consultant. In return, the settlements become confidential.

David L. Sadowski, executive director of the Crater District Area Agency on Aging, says he is surprised that the U.S. Attorney would make confidential settlements since that practice is "defeating to the public." He insists that all federal actions against nursing homes should be disclosed. The Washington Post reports that "although it is not uncommon for private lawyers to keep settlements secret, the idea that federal prosecutors would withhold information about nursing home quality has confused and angered some advocates."

These settlements with the Alexandria office seem to run contrary to recent federal efforts to make nursing home care and its deficiencies more transparent. Some U.S. attorneys in other states even list nursing home settlements on their Web pages. Medicare also publishes information about staffing levels and deficiencies in care on their website. Even the Senate is pushing for greater transparency in nursing home care. Senator Charles Grassley (R-Iowa) has introduced a bill that would require the Department of Justice to report details of settlements exceeding $100,000.

However Paul McNulty argues that his office has been trying to shift the focus of nursing home cases from paying fines to improving care. He says that "the principal difference between this approach and others . . . is using those monies to improve the facilities themselves." He thinks working with the owners to fix the problems as opposed to putting money into the federal treasury is a better solution. McNulty has made one of the most recent settlements with Beverly Healthcare public. In that case, the owners were required to spend $315,000 to hire five additional caregivers and an outside expert; in exchange, the owners denied any wrongdoing.

Alice H. Hedt, executive director of the National Citizens' Coalition on Nursing Home Reform says that "the public has a right to know if a facility has been sanctioned, what the sanction was and what it was for." She says further that "a fine is one of the few things in our system that is a very clear indicator that the facility has experienced very serious problems." The U.S. Attorney in Pennsylvania, David Hoffman, thinks that "as much information as you can have in making a selection of a nursing home is critical...that's one of the reasons we make public all of our nursing home settlements. It's important for the consumers, who have a stake in this, and to keep the homes honest."